Vanceman
Welcome! Hope this helps:-
You can burn one off with a laser and urologists here (UK) also use something called a diathermy loop which uses electric current to cut out divots from the bladder lining and is used to extract tumours and cauterises simultaneously. I'm sure I've had very small tumours burnt off whole - but I guess only when they are sure they are ok as I don't think they make great biopsy samples. Those are the ones I know - anyone else? I think your wife is right about the oncologist angle, I'm under a uro-oncologist which makes me happy that all bases are covered. If you're happy with him though, that's what's important.
Flattish tumour; could be a cessile (flat) tumour or CIS (carcinoma in situ) but I wouldn't really like to say as there's not much to go on with that description. "a form of chemo treatment" may indicate the latter (cis is often treated with BCG - a wash containing a strain of TB to stimulate an immune response) but again there isn't lot to go on here. It could just be a flat tumour and he may be considering a wash with mitomycin (an antibiotic that targets particular cells).
Two great expressions here are "non invasive" and "low grade". Tumours are graded 1 -3 (1 being highest) and this dictates the aggressiveness of the tumour. I don't like the word aggressive as it isn't always necessarily true but it describes how unlike the original source (bladder cells) the tumour cells have become and how likely it would be to spread given the chance. Non-invasive means it's probably a low stage cancer and this is very important in seeing how far it's gone. yours sounds superficial which is good news. Stages go from Ta (superficial), T1 T2 etc and various points between. A Ta tumours "roots" don't go any further than the bladder lining (epithelium) later stages go further through the different layers until they reach a layer where they can access lymphatics and bloodstream - thus the rest of the body. Stage can have a massive bearing (more than grade in some ways) on how you're treated and if a late stage is indicated can mean more aggressive treatment as it may point to a greater likelihood of spread. Doesn't sound like this is your situation at all. This information would be useful for us here. Not that we're doctors or anything like it but it may get you some helpful feedback on other people's experiences.
The first tumour you describe - papillary - means it has a stalk. If you look at these under a scope they look like seaweed, quite innocent looking really. The size of yours is kind of average or slightly bigger in my experience. but while size can be important it often isn't. the last tumour I had - the one which I made the decision to have my bladder removed on (it was high grade) was teeeny. Like a pinhead. the frequency, location and number of recurrences may also have a bearing on your treatment over time. A1 to A4...haven't a clue! Anyone?
I think your assessment is broadly correct and, while it's always best not to worry if you can (it rarely achieves much but is hard to avoid!) make sure you keep on top of things and keep asking questions. Don't be afraid of second opinions and hurting your docs feelings. It's still a cancer you're dealing with. The fact you've posted here indicates that you're on the case. Keep asking questions.
Here's a link to another page on this site with useful information on staging and grading. Have a good look around; there's lots of useful stuff on here. It's not everyone's bag but knowledge is power. You may even find out what A1 - A4 is !
blcwebcafe.org/staging.asp
All the best
Tim
